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201608462
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Last modified
12/19/2016 7:58:53 AM
Creation date
12/19/2016 7:58:53 AM
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DEEDS
Inst Number
201608462
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4. Severability. If any part of any provision of this instrument shall be invalid or unenforceable <br />under applicable law, such part shall be ineffective to the extent of such invalidity only, without in any way <br />affecting the remaining parts of such provision or the remaining provisions of this instrument. <br />5. Governing Law and Applicability to Foreign Jurisdictions. This instrument shall be <br />governed by the laws of the State of Nebraska in all respects, including its validity, construction, <br />interpretation and termination, and to the extent permitted by law shall be applicable to all property of mine, <br />real, personal, intangible or mixed, wherever and in whatever state of the United States or foreign country the <br />situs of such property is at any time located and whether such property is now owned by me or hereafter <br />acquired by me or for me by my Agent. <br />6. Photocopies. My Agent is authorized to make photocopies of this instrument as frequently <br />and in such quantity as my Agent shall deem appropriate. All photocopies shall have the same force and <br />effect as any original. <br />1� <br />LAMSON, DUGAN AND MURRAY, LLP <br />ATTORNEYS AT LAW <br />ARTICLE XI <br />HIPAA RELEASE AUTHORITY <br />I intend for my Agent to be treated as I would be with respect to my rights regarding the use and <br />disclosure of my individually identifiable health information or other medical records. This release authority <br />applies to any information governed by the Health Insurance Portability and Accountability Act of 1996 <br />(HIPAA), 42 USC §1320d and 45 CFR §§160-164. I authorize any physician, health -care professional, <br />dentist, health plan, hospital, clinic, laboratory, pharmacy or other covered health -care provider, any <br />insurance company and the Medical Information Bureau, Inc. or other health -care clearinghouse that has <br />provided treatment or services to me, or that has paid for or is seeking payment from me for such services, to <br />give, disclose and release to my Agent, without restriction, all of my individually identifiable health <br />information and medical records regarding any past, present or future medical or mental health condition, <br />including all information relating to the diagnosis and treatment of HIV /AIDS, sexually transmitted diseases, <br />mental illness, and drug or alcohol abuse. The authority given my Agent shall supersede any prior agreement <br />that I may have made with my health -care providers to restrict access to or disclosure of my individually <br />identifiable health information. The authority given my Agent has no expiration date and shall expire only in <br />the event that I revoke the authority in writing and deliver it to my health -care provider. <br />ARTICLE XII <br />REVOCATION <br />This instrument may be amended or revoked by me, and my Agent and any alternate Agent may be <br />removed by me at any time by the execution by me of a written instrument of revocation, amendment, or <br />removal delivered to my Agent or any acting alternate Agents. If this instrument has been recorded in the <br />public records, then the instrument of revocation, amendment or removal shall be filed or recorded in the <br />same public records. My Agent and any alternate Agent may resign by the execution of a written resignation <br />delivered to me or, if I am mentally incapacitated, by delivery to any person with whom I am residing or who <br />has the care and custody of me or in the case of an alternate Agent, by delivery to my Agent. In the event I <br />am incapacitated this Power can be revoked only by the conservator of my estate as appointed by a court of <br />competent jurisdiction. I hereby revoke all prior Durable or General Powers of Attorney that I may have <br />executed. <br />5 <br />201608462 <br />
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